[Deactualization and orthostrophy. Phenomenological psychopathology of receding delusions]. / Entaktualisierung und Orthostrophe. Zur phänomenologischen Psychopathologie des abklingenden Wahns.

In this article we develop a phenomenological psychopathology of receding delusions in persons with a diagnosis of schizophrenia. Drawing on Klaus Conrad's (1905-1961) descriptions of beginning schizophrenia and an in-depth single case study, we develop descriptions of the process of receding delusions as opposed to ongoing delusions in the manner of a double-orientation to reality. We distinguish two stages in this process of social recovery and term these stages deactualization and orthostrophy. We argue that delusional convictions lose importance and persuasive power if they are no longer supported by corresponding value apprehensions or perceptions and perception-like experiences (i.e. hallucinations). Consequently, we propose that the process of receding delusions proceeds in layers comparable to a regression of the process of upcoming delusions. Lastly we discuss both stages of receding delusions (deactualization and orthostrophy) and ongoing delusions (double-orientation to reality) as possible continuous manners of social recovery concerning delusional psychosis (diagnosis of schizophrenia) and argue for specific interventions according to these different continuous manners.

[In truth could nothing on earth help? Kleist's suicide from a psychiatric perspective]. / In Wahrheit auf Erden nicht zu helfen? Kleists Suizid aus psychiatrischer Sicht.

Heinrich von Kleist (1777-1811) was a German poet and dramatist. During the celebrations marking the 200th anniversary of his death in November 2011, his double suicide with Henriette Vogel on the shores of the Kleine Wannsee near Berlin was extensively and publicly debated in Germany. The meticulous reconstruction of his suicidal condition demonstrates that often only a few aspects of this condition are highlighted in German-speaking feuilleton or biographies. Contrasting the popular stylization of Kleist's suicide as a "well-defended deliberate self-killing" or a "romantic double suicide" it is argued that: (a) retrospective psychiatric diagnosis or psychological models of explanation are necessarily questionable (so-called pitfall of pathography), (b) Kleist's mental narrowness regarding suicide as a behavioral option was multifactorially motivated and (c) his sentence "The truth is that on earth no help was possible for me" clearly expresses his desperation but delivers no justification for his suicide. On the contrary, from a clinical ethical point of view suicide can only be justified if no improvement of the condition is objectively possible. Even if this would have been the case in Kleist's time, nowadays modern psychotherapeutic and pharmacological means are reliably and easily able to help people in comparable situations. With a discussion and meticulous reconstruction this paper increases the understanding of Kleist's suicide and opens a clear view on his life and works.

[Karl Jaspers : Tasks and limitations of psychotherapy]. / Karl Jaspers. Aufgaben und Grenzen der Psychotherapie.

Using Jaspers' methodically critical attitude (methodenkritische Einstellung) we distinguish three aspects of his understanding of psychotherapy: (1) psychotherapy gains scientific quality via methodical strictness (and is therefore independent of a therapist's weltanschauung); (2) psychotherapy is a (more or less) 'hermeneutical' method of self-enlightenment, offering limited statements with respect to one's life conduct; and (3) psychotherapy oversteps its epistemological limits if gaining the status of a weltanschauung, instead of leading to (existential) philosophizing in the face of transcendence. Following Jaspers we try to answer the question: What are the limits of psychotherapeutic methods with respect to questions of life conduct? The most important limit is the unbreakable linkage between the style of one's life conduct and the (personally) experienceable (superpersonal) sense of life, which cannot be disrupted with the means of any justifiable belief or falsifiable knowledge. Quite to the contrary, this existential linkage is the starting point of many psychotherapeutic interventions.

[Hölderlin--or the question of the meaning of psychosis]. / Hölderlin oder die Frage nach dem Sinn des Psychotischen.

Friedrich Hölderlin (1770-1843) is one of the most important German poets. Actual research into his life and work has shown new aspects in his thinking concerning questions about subjectivity, sense of life and psychosis. We follow these lines using a hermeneutical method. In his late poems the experience of schizophrenic alienation appears metaphorically speaking like an ebbing of a former plenitude of meanings or as if he were decentered from his own life. Hölderlin names it an "uninvolved" view onto the ordinary life. Hölderlin invites and enables us via his offer for an innerperspective understanding of the schizophrenic experience of alienation to deal fairly and respectfully with schizophrenic patients as if we were "alienists" (E. Straus).

[An anthropological view of addiction]. / Zur philosophischen Anthropologie der Sucht.

In psychiatric discourse, addiction is normally understood according to the original paradigm of "dependency" which claims lifelong and unchangeable dependency on the addictive substance or "psychotropic technique". In the attempt to reduce damage or achieve abstinency, therapeutic interests and understanding of the human mind contradict this inflexibility. This contradiction in psychiatric understanding of addiction can be viewed as a dynamic part of the addiction process. A philosophical anthropology of addiction is presented in that light. Using the concept "the psychotropic technique achieves a superior position", both sides of the psychiatric understanding are combined and integrated. The addictive mind and its self-awareness can then be understood as a "fragile monoidentity". Implications of such an understanding are discussed.